Provider Demographics
NPI:1245448109
Name:CAROLINA NUCLEAR
Entity type:Organization
Organization Name:CAROLINA NUCLEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUFFRONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-7776
Mailing Address - Street 1:PO BOX 3457
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3457
Mailing Address - Country:US
Mailing Address - Phone:787-757-5985
Mailing Address - Fax:787-757-6190
Practice Address - Street 1:AVENUE MONSERRATE
Practice Address - Street 2:VALLE ARRIBA HEIGHTS AC8
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-757-5958
Practice Address - Fax:787-757-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89161Medicare PIN